Use Of Opioids For Pain Management Research Articles

Mental Health and Substance Use Disorders in Transplant Waitlist, VAD, and Heart Transplant Patients: A TriNetX Database Analysis

Background/Objectives: Mental health and substance use disorders (MHDs and SUDs) affect cardiac allograft and VAD recipients and impact their quality of life and compliance. Limited research currently exists on MHDs and SUDs in this population. Methods: This study compares the incidence of MHDs and SUDs in the transplant list, VAD, and post-transplant patients with that in heart failure patients. Study cohorts were derived from the TriNetX database using ICD-10 codes. Differences in incidence were examined using the log-rank test. Adults with MHDs and SUDs before the window of time were excluded. All comparisons were made between propensity-matched cohorts. Statistical significance was set at p < 0.05. Results: Transplant waitlist patients showed a significant increase in the incidence of anxiety, depression, panic, adjustment, mood, alcohol use, and eating disorders. Post-transplant patients showed a significant increase in depression and opioid use. VAD patients showed a significant increase in depression and a decrease in panic disorder and anxiety. These results allow for further investigations on prevention and coping strategies. Conclusions: The deterioration of mental health can significantly impact medication compliance, survival, and quality of life. Opioid use for pain management in the early postoperative period should be further investigated to assess its impact on long-term substance use and addiction.

P100 Clinical Indications Associated with New Opioid Use for Pain Management in the United Kingdom: Using National Primary Care Data

Abstract Background/Aims Prescription opioids for non-cancer pain in the UK have increased over the past two decades, alongside associated harms. There is an increasing recognition that policies to address opioid prescribing need to be tailored according to individual patient needs with specific indications and disease systems. This study aimed to evaluate clinical indications associated with new opioid initiation in non-cancer pain using UK large-scale data. Methods National primary care electronic health records from 01/01/2006 to 31/20/2021 were used from the Clinical Research Practice Datalink. Codelists for opioid-related conditions based on literature and experts in pain management, primary care, rheumatology, and pharmacy were applied to a one-year period before first opioid prescription for surgical indications (given the acute nature) and five-years prior for chronic conditions. Descriptive statistics were used for data analysis, accounting for overlapping indications. Results A total of 3,031,950 new opioid users were identified. Opioids were initiated more commonly in women (60.7%), people in age groups: 45-64 (40.0%) and ≥65 years (37.0%). Nine systems associated with opioid-initiation were identified. The most common were musculoskeletal (74.0%), respiratory (53.1%), infections (25.7%), trauma/injury (16.1%), neurology (16.0%), gastrointestinal (4.2%) within five years prior to the opioid prescription date and post-surgical within one-year prior (3.8%). Musculoskeletal conditions most frequently associated with opioid use were osteoarthritis (n = 1,536,338, 50.7%), low back pain (1,094,163, 36.1%), other non-inflammatory musculoskeletal conditions 344,3412 (11.4%), rheumatoid arthritis 63,365 (2.1%) and fibromyalgia 56,038 (1.9%). Post-surgical indications were associated with 3.8% of all prescriptions, with orthopaedic surgeries being the most common: 42.1% of all post-surgical indications, including total knee replacements (n = 31,944; 27.6%) and total hip replacements (n = 17,863; 14.5%). Conclusion This is the first study in the UK evaluating large scale national data to assess indications associated with opioid initiation. Almost three quarters of the new prescriptions of opioids for non-cancer pain were in people with a diagnosis of a musculoskeletal condition. Orthopaedic surgeries contributed to a third of all post-surgical indications. These findings could help inform prioritisation of targeted interventions in opioid de-prescribing, clinical vigilance, and policy development to support non-pharmacological interventions in patients with musculoskeletal conditions. Disclosure M. Lyon: None. C. Ramirez Medina: None. E. Davies: None. M. Jani: None.

Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis.

Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.

Diagnosis and management of secondary adrenal crisis.

Adrenal crisis (AC) is a life threatening acute adrenal insufficiency (AI) episode which can occur in patients with primary AI but also secondary AI (SAI), tertiary AI (TAI) and iatrogenic AI (IAI). In SAI, TAI and IAI, AC may develop when the HPA axis is unable to mount an adequate glucocorticoid response to severe stress due to pituitary or hypothalamic disruption. It manifests as an acute deterioration in multi-organ homeostasis that, if untreated, leads to shock and death. Despite the availability of effective preventive strategies, its prevalence is increasing in patients with SAI, TAI and IAI due to more frequent exogenous steroid administration, pituitary immune-related effects of immune checkpoint inhibitors and opioid use in pain management. The delayed diagnosis of acute AI which remains infrequently suspected increases the risk of AC. Its main precipitating factors are infections, emotional distress, surgery, cessation or reduction in GC doses, pituitary infarction or surgical cure of endogenous Cushing's syndrome. In patients not known previously to have SAI/TAI/IAI, recognition of its symptoms, signs, and biochemical abnormalities can be challenging and cause delay in proper diagnosis and therapy. Effective therapy of AC is rapid intravenous administration of hydrocortisone (initial bolus of 100mg followed by 200mg/24h as continuous infusion or bolus of 50mg every 6h) and 0.9% saline. In diagnosed patients, preventive education in sick-day rules adjustment of glucocorticoid replacement and hydrocortisone parenteral self-administration must be performed repeatedly by trained health care providers. Strategies to improve the adequate preventive education in patients at risk for secondary AI should be promoted in collaboration with various medical specialist societies and patients support associations.

Opioid Treatment in Primary Care: Knowledge and Practical Use of Opioid Therapy.

Primary care physicians play a key role in initiating opioid therapy. However, knowledge gaps in opioid use and pain management are significant barriers to providing optimal care. This research study aims to investigate the educational needs of primary care physicians regarding opioid therapy and opioid use in pain management. A computer-assisted web interview (CAWI) protocol was used to collect data from primary care physicians. Drug selection criteria, knowledge of opioid substitutes and dosage, and practical use of opioid therapy were evaluated. While 84% of participating physicians (724 respondents) reported initiating opioid treatment, only a minority demonstrated accurate opioid dosage calculations. Significant discrepancies between physicians' self-perceived knowledge and their clinical skills in opioid prescribing and pain management were observed. In total, 41% of physicians incorrectly indicated dose conversion rates for tramadol (the most frequently used drug according to 65% of responders). Targeted educational programs are essential to bridge the knowledge gap and increase physicians' competence in pain management. The proper self-assessment of one's own skills may be the key to improvement. Further research should focus on developing specialized educational courses and decision-support tools for primary care physicians and examining the impact of interprofessional pain management teams on patient outcomes.

Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study

ObjectivesIncreased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective...

The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review

Introduction: The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest. Patients and methods: Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes. Discussion: There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression. Conclusion: Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.

The impact of AirSeal® on complications and pain management during robotic-assisted radical prostatectomy: a single-tertiary center study.

We aimed to compare perioperative outcomes, post-operative complications, and opioid use between AirSeal® and non-AirSeal® robotic-assisted radical prostatectomy (RARP). We retrospectively collected data on 326 patients who underwent elective RARP at our institution either with or without AirSeal®. The first 60 cases were excluded accounting for the institutions' learning curve of RARP. Patient demographics, oncologic, pathologic, and surgical characteristics between AirSeal® and non-AirSeal® cases were compared. Furthermore, outcomes of interest including operative time, length of stay, morbidity, and opioid use for pain management were compared between the two groups. Univariate linear and logistic regression models were developed. The AirSeal® group consisted of 125 (38.3%) patients while the non-AirSeal® group consisted of 201 (61.7%) patients. No statistically significant difference was seen in terms of patient demographics, oncologic characteristics, surgical characteristics, and pathologic characteristics between the two groups. In addition, univariate linear regression showed that RARP with AirSeal® displayed shorter operative times by 12.3 min and a shorter length of hospital stay by 0.5 days compared to the non-AirSeal® group (p < 0.001). Furthermore, the AirSeal® group witnessed lower odds of Clavien-Dindo (CVD) Class > 2 complications (OR = 0.102) and a lower need for opioid use (OR = 0.49) compared to the non-AirSeal® group (p < 0.022). RARP using AirSeal® is associated with shorter operative times, shorter length of hospital stays, lower odds of CVD > 2 complications, and lower odds of opioid use with respect to non-AirSeal® RARP. The efficacy and cost effectiveness of using the AirSeal® system during RARP should be further studied and evaluated by clinical trials.

MP80-03 OPIOID USE IN VETERANS WITH PROSTATE CANCER FOLLOWING SURGERY TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP80-03 OPIOID USE IN VETERANS WITH PROSTATE CANCER FOLLOWING SURGERY TREATMENT Sumedha Chhatre, S Bruce Malkowicz, Thomas Guzzo, Marilyn Schapira, and Ravishankar Jayadevappa Sumedha ChhatreSumedha Chhatre More articles by this author , S Bruce MalkowiczS Bruce Malkowicz More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Marilyn SchapiraMarilyn Schapira More articles by this author , and Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Opioid use for pain management in cancer patients is a challenge. Study objective was to determine the incidence of persistent opioid use in Veterans with early stage prostate cancer and treated with surgery. METHODS: Retrospective cohort study of Veterans diagnosed with prostate cancer between 2015 and 2016. Opioid exposure attributable to treatment was defined as the cumulative oral or topical Morphine Milligram Equivalents (MMEs) prescribed from 31 days prior to 14 days post index surgery. Outcome was any opioid use in the 13-month follow-up period. Eligibility criteria was Veterans receiving care at a VA Medical Center, aged ≥21 years, early stage prostate cancer, surgery treatment at VA Medical Center, and opioid naïve in the period 12 months to 31 days prior to index surgery. Logistic regression was used to model association between any opioid use in the follow-up period as a function of any baseline opioid use, baseline opioid use (MMEs), age, race, ethnicity, socio-economic status, dual enrollment-Medicare Part D, comorbidity, mental health conditions, chronic pain, non-opioid pain medications, cancer treatment (adjuvant chemotherapy, radiation, immunotherapy), and district. RESULTS: 2,594 Veterans with prostate cancer met our criteria. Proportion of Veterans with opioid use during the 13-moth follow-up period is shown in Table 1. The largest opioid use was observed in the first follow-up month (31.5%), and 42.5% had at least one month of opioid use in the follow-up period. Baseline opioid use (OR=5.3, 95% CI=4.1, 6.9), diagnosis year 2015 (OR=1.6, 95% CI=1.3, 1.9), Elixhauser comorbidity score of 1-3 (OR=1.9, 95% CI=1.4, 2.7), chronic pain (OR=1.4, 95% CI=1.2, 1.7), anxiety, depression or PTSD (OR=1.4, 95% CI=1.1, 1.8), and Pacific district were associated with higher risk of opioid use in the follow-up period. Dual Medicare enrollment (OR=0.73, 95% CI=0.57, 0.94), and cancer stage I (OR=0.44, 95% CI=0.30, 0.63) were associated with lower risk of opioid use in follow-up period. CONCLUSIONS: Opioid use immediately after surgery was associated with continued opioid use in the follow-up period. This has implications for optimizing pain management for Veterans with prostate cancer. Source of Funding: VA HSR&D PPO 20-121 and DoD W81XWH-19-1-0461 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1152 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumedha Chhatre More articles by this author S Bruce Malkowicz More articles by this author Thomas Guzzo More articles by this author Marilyn Schapira More articles by this author Ravishankar Jayadevappa More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-13 THE IMPACT OF AIRSEAL ® ON COMPLICATIONS AND PAIN MANAGEMENT DURING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: A SINGLE-TERTIARY CENTER RETROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP26-13 THE IMPACT OF AIRSEAL® ON COMPLICATIONS AND PAIN MANAGEMENT DURING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: A SINGLE-TERTIARY CENTER RETROSPECTIVE STUDY Christian Habib Ayoub, Alexandre Armache, Jose M. El-Asmar, Suhaib Abdulfattah, Nayda Bidikian, Elia Abou Chawareb, Elio Hoyek, and Albert El Hajj Christian Habib AyoubChristian Habib Ayoub More articles by this author , Alexandre ArmacheAlexandre Armache More articles by this author , Jose M. El-AsmarJose M. El-Asmar More articles by this author , Suhaib AbdulfattahSuhaib Abdulfattah More articles by this author , Nayda BidikianNayda Bidikian More articles by this author , Elia Abou ChawarebElia Abou Chawareb More articles by this author , Elio HoyekElio Hoyek More articles by this author , and Albert El HajjAlbert El Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AirSeal® is a valveless insufflation device that allows a stable pneumoperitoneum through continuous smoke evacuation and CO2 recirculation during laparoscopic surgery. We aimed to compare surgical characteristics, post-operative complications, and opioid use between AirSeal® and non-AirSeal® robotic-assisted radical prostatectomy (RARP). METHODS: Data on 395 patients who underwent elective RARP with or without AirSeal® at our institution were retrospectively collected between 2013 and 2022. We compared patient demographics, oncologic, pathologic, and surgical characteristics between AirSeal® and non-AirSeal® cases. We also compared operative time, length of stay, morbidity, and opioid use for pain management between the two groups. Multivariable linear and logistic regression models, controlling for age, extra-prostatic extension, prostate size, and pathological grade on TRUS were developed to control for confounders. RESULTS: The AirSeal® and non-AirSeal® group consisted of 125 and 270 patients respectively. Patients who underwent RARP with AirSeal® were older, more likely to have a clinical grade ≥ 3, and more likely to have extraprostatic extension as compared to patients who did not use AirSeal® (p<0.039). RARP with AirSeal® displayed shorter operative times by 29.2 minutes and length of hospital stay by 0.72 days as compared to non-AirSeal® group (p<0.001). Furthermore, the AirSeal® group also witnessed lower odds of Clavien-Dindo Class >2 complications (OR= 0.06) and opioid use (OR= 0.46) as compared to non-AirSeal® group (p<0.022). CONCLUSIONS: RARP combined with AirSeal® in our center was associated with shorter operative times, shorter length of hospital stays, lower odds of CVD>2 complications, and lower odds of opioid use in comparison to non-AirSeal® RARP. The feasibility and efficacy of combining the AirSeal® system during RARP should be further studied and evaluated by randomized clinical trials. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e358 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Habib Ayoub More articles by this author Alexandre Armache More articles by this author Jose M. El-Asmar More articles by this author Suhaib Abdulfattah More articles by this author Nayda Bidikian More articles by this author Elia Abou Chawareb More articles by this author Elio Hoyek More articles by this author Albert El Hajj More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient and Family Opioid Decision-Making for Pain Management in Sickle Cell Disease: A Qualitative Study

Pain is a significant symptom experienced frequently by individuals with sickle cell disease (SCD). Pain management includes strategies such as oral rehydration, non-pharmacological therapies (eg, massage, relaxation), and oral analgesics and opioids. Shared decision-making around pain management is emphasized repeatedly in recent guidelines; however, research is sparse regarding factors to be considered in shared decision-making approaches including the perceived risks and benefits of opioids. This qualitative descriptive study was conducted to explore perspectives of decision-making for opioid medications in SCD. We conducted 20 in-depth interviews with caregivers of children with SCD and individuals with SCD to elucidate the decision-making processes around home use of opioid therapy for pain management at a single center. Themes were identified in the domains of the Decision Problem (Alternatives and Choices; Outcomes and Consequences; Complexity), the Context (Multilevel Stressors and Supports; Information; Patient-Provider Interactions), and the Patient (Decision-Making Approaches; Developmental Status; Personal and Life Values; Psychological State). Key findings indicated opioid management for pain in SCD is important yet complex and requires collaboration among patients, families, and providers. Elements of patient and caregiver decision-making identified in this study may be applied to shared decision-making strategies in the clinical setting and future study. PerspectiveThis study illustrates the factors involved in decision-making around home opioid use for pain management in children and young adults with SCD. These findings can be applied to determining shared decision-making approaches around pain management between providers and patients, in accordance with recent SCD pain management guidelines.

Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study

Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.

Burden of opioid use for pain management among adult herpes zoster patients in the US and the potential impact of vaccination

ABSTRACT The goal of this research was to describe treatment patterns, health-care resource utilization, and costs for herpes zoster (HZ)-related pain, and to estimate the potential impact of recombinant zoster vaccine (RZV) on avoided HZ cases and HZ-related pain prescriptions. This retrospective claims database study included patients from commercial, Medicare, and Medicaid plans between 2012 and 2017. Subjects with an HZ episode were assigned to three cohorts: “opioid”, “non-opioid”, and “no-treatment” cohorts. Subjects in the opioid cohort were matched to a non-HZ cohort. The potential impact of RZV vaccination on HZ case avoidance and resulting painkiller prescriptions was modeled. Over 25% of subjects with an HZ episode received opioids. Adjusted health-care costs were approximately double in the opioid cohort versus non-opioid or matched non-HZ cohorts. Postherpetic neuralgia, immunocompromised status, and comorbidities increased the risk for opioid prescription. RZV vaccination was predicted to avoid over 19,000 patients from receiving opioid prescriptions for every 1 million adults aged ≥50 years. HZ-related prescriptions of opioids were common and led to increased health care costs. RZV vaccination may potentially reduce opioid prescriptions through decreasing HZ incidence.

Striking a Balance With Opioid Use for Pain Management After Thoracic Surgery

Pain management for patients undergoing thoracic surgery is of paramount importance. As many as one-third of patients undergoing thoracic surgery, regardless of approach, may develop chronic pain 1 Bayman E.O. Parekh K.R. Keech J. Selte A. Brennan T.J. A prospective study of chronic pain after thoracotomy. Anesthesiology. 2017; 126: 938-951 Crossref PubMed Scopus (124) Google Scholar defined as pain related to surgery lasting at least 3 months. An independent predictor of chronic pain is pain intensity during the early postoperative period. 1 Bayman E.O. Parekh K.R. Keech J. Selte A. Brennan T.J. A prospective study of chronic pain after thoracotomy. Anesthesiology. 2017; 126: 938-951 Crossref PubMed Scopus (124) Google Scholar Therefore optimal pain management immediately after surgery is crucial. Furthermore 14% of lung cancer resection patients become new persistent opioid users, meaning they fill an opioid prescription for surgery and at least 1 additional prescription 3 months after surgery. 2 Brescia A.A. Harrington C.A. Mazurek A.A. et al. Factors associated with new persistent opioid usage after lung resection. Ann Thorac Surg. 2019; 107: 363-368 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Surgeons must strike a balance with opioids by prescribing them judiciously as part of a multimodal analgesia strategy to optimize postoperative pain management while minimizing risk of prolonged use. As eloquently stated by Travis Rieder, PhD, bioethicist, in his book entitled, In Pain, “We don’t have a prescription opioid problem; we have a pain problem that opioids happen to play a significant role in.” (page 157). 3 Rieder T. In Pain: A Bioethicist’s Personal Struggle with Opioids. HarperCollins, 2019 Google Scholar Multimodal Pain Management Protocol to Decrease Opioid Use and to Improve Pain Control After Thoracic SurgeryThe Annals of Thoracic SurgeryVol. 114Issue 6PreviewOpioid addiction continues to be a devastating problem in our communities, and up to 40% of patients begin their addiction with legally prescribed opioids after injury or surgical procedure. An opioid-free multimodal pain regimen was developed with the goal of decreasing opioid exposure while maintaining adequate pain control. Full-Text PDF

Nurses' Perspectives on Postpartum Pain Management.

Introduction:There is variation in postpartum opioid use by prescriber characteristics that cannot be explained by patient or birth factors. Thus, our objective was to evaluate nursing training, clinical practices, and perspectives on opioid use for postpartum pain management.Materials and Methods:In this survey study, postpartum bedside nurses at a single, large academic center were asked about training, factors influencing clinical decisions, and viewpoints regarding pain management and opioid use. Findings were summarized using descriptive analyses.Results:A total of 92 nurses completed the survey. A majority (77%) reported having received some formal training on opioid use for pain management. About a quarter (25.7%) felt their training was not adequate. Regarding clinical practices, the majority (71% and 70%, respectively) reported that “routine habit” and “patient preference” most influenced the type and amount of pain medication they administered. Finally, nurses' perspectives on pain management demonstrated a wide range of beliefs. Most nurses strongly agreed with the importance of maximizing nonopioid pain medication before opioid administration. The majority agreed that patient-reported pain score is important to consider when deciding to administer opioids. Conversely, most nurses disagreed that patients should be encouraged to endure as much pain as possible before using an opioid. Similarly, beliefs about the reliability of use of vital signs in assessing pain intensity varied widely.Conclusions:Bedside nurses rely on routine habits, patient preference, and patient-reported pain score when administering opioids for postpartum pain management. Increased training opportunities to improve consistency and standardization of opioid administration may be beneficial.

Primary horizontal mattress uterine closure compared to conventional running lock closure at cesarean section

The aim of this study is to compare peri-operative outcomes for cesarean section (C-section) uterine closure with primary horizontal mattress suture to conventional single-layered running lock suture, with respect to estimated and quantitative operative blood loss, change in hemoglobin and hematocrit, length of hospital stay, and use of opioids for pain management during post-operative hospital admission. A retrospective cohort chart review was performed on patients undergoing elective primary or repeat cesarean section at a hospital in South Florida between January 2016 and August 2020. Of 506 included patients, 176 had primary horizontal mattress uterine closure completed by a single physician and 330 had conventional uterine closure completed by other physicians in the same hospital. None of the patients in either group were in labor or had spontaneous rupture of membranes. Demographic, clinical, and post-operative outcomes were collected from their operative note, post-operative note and progress note and then compared for each group. Baseline demographic and clinical features, including pre-pregnancy BMI, admission year, gravida, para, pre-surgery hemoglobin, and hematocrit were statistically similar. After adjusting for admission year, maternal age, and maternal race/ethnicity, the primary horizontal mattress closure demonstrated significantly lower estimated blood loss (EBL) (p<0.001) and smaller difference between pre- and post-c-section hemoglobin (p<0.027) and hematocrit (p<0.014) when compared to conventional closure methods. In addition, there was significant reduction in the length of total and post-surgical hospital stay (p<.001). There were no significant differences in quantitative blood loss (QBL) or percentage of patients using opioids during their hospital stay and no increase in infectious morbidity, need for blood transfusion. Post-cesarean section uterine closure with the single layered horizontal mattress suture technique provides a reasonable alternative during closure of hysterotomy leading to decreased operative blood loss, shorter duration of hospital stay, and reduction in opioid use for pain management. Although historically obstetricians perform a single-layered running lock uterine closure at the time of cesarean sections, our data supports that primary horizontal mattress uterine closure is a viable and effective option in providing an optimal post-operative course in patients undergoing a C-section. Prospective studies to confirm the value of uterine closure with the primary horizontal mattress are warranted.

An overview of the use and misuse/abuse of opioid analgesics in different world regions and future perspectives.

Opioids are an important therapeutic option for severe resistant chronic pain but, in the absence of proper oversight, their use has risks. The level of prescription opioid misuse/abuse differs among countries, due to differences in healthcare systems and pain management approaches. However, evaluating the true dimension of prescription opioid misuse/abuse is complicated by statistical reporting which often does not differentiate between prescription and illicit opioid use, or between prescription opioid use by patients and nonpatients, highlighting a need for greater uniformity. Parallel efforts to educate patients and the general public about opioid risks, facilitate appropriate analgesic prescribing and identify alternative formulations or options to use instead of or with opioids, may contribute to optimizing prescription opioid use for pain management.

Interventions to reduce opioid use after cesarean birth: a systematic review

As deaths related to opioids continue to rise, reducing opioid use for pain management following cesarean birth is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following cesarean birth.

Successful Sublingual Buprenorphine Induction and Maintenance for Opioid Use Disorder in a Patient With Reduced Salivary Production, Aspiration Pneumonia, and an Enteral Tube.

There are multiple factors to consider while initiating medications for opioid use disorder. Mr A is a 66-year-old man with a 17-year history of opioid use for pain management after completing cancer treatment. Read on to find out more.

The Greatest Evil is Physical Pain

Physicians should continuously review their understanding of fundamental labels, definitions, and differentiation of medicine, especially when dealing with intricate pain management issues. The basic pathology of pain, the distinction of the different types of pain—nociceptive, neuropathic, acute, and chronic—and diagnosis methods are discussed. A summary of treatment methods for types of pain and important reminders regarding opioid use in pain management are also outlined.